Healthcare Provider Details

I. General information

NPI: 1063529089
Provider Name (Legal Business Name): JUDITH F KATZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST BOX 7105
BOSTON MA
02111-1526
US

IV. Provider business mailing address

800 WASHINGTON ST BOX 7105
BOSTON MA
02111-1552
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone: 617-636-7105
  • Fax: 617-636-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number43033
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: